-
Fertility and Sterility Mar 2019Infertility due to nonobstructive azoospermia is treatable with the use of testicular sperm extraction and IVF. The optimal approach for sperm retrieval is...
Infertility due to nonobstructive azoospermia is treatable with the use of testicular sperm extraction and IVF. The optimal approach for sperm retrieval is microdissection testicular sperm extraction (mTESE). This systematic review summarizes and evaluates the literature pertaining to patient optimization before mTESE, mTESE technique, and post-mTESE testicular tissue processing. Preoperative patient optimization has been assessed in terms of adjuvant hormone therapy and varicocele repair. Limited data are available for adjuvant medical therapy, and although also limited, data for varicocele repair support increased sperm retrieval, pregnancy, and return of sperm to the ejaculate. Post-mTESE tissue processing has few comparative studies; however, most studies support the combination of mechanical mincing and use of type 4 collagenase for tissue disintegration along with pentoxifylline to assist in identifying motile and viable spermatozoa for intracytoplasmic sperm injection.
Topics: Azoospermia; Fertility; Humans; Infertility, Male; Male; Microdissection; Risk Factors; Sperm Injections, Intracytoplasmic; Sperm Retrieval; Spermatogenesis; Testis; Treatment Outcome; Urologic Surgical Procedures, Male
PubMed: 30827516
DOI: 10.1016/j.fertnstert.2019.01.003 -
Andrologia Dec 2019To investigate whether bilateral surgery can bring more benefits to infertile patients with bilateral varicocele than unilateral surgery. A search of PubMed, Web of... (Meta-Analysis)
Meta-Analysis
To investigate whether bilateral surgery can bring more benefits to infertile patients with bilateral varicocele than unilateral surgery. A search of PubMed, Web of Science, EMBASE and the Cochrane Library on 13 January 2019 was conducted to identify studies published in English that used varicocelectomy. The protocol of the present meta-analysis was pre-published on PROSPERO (registration number CRD42019093894). Primary outcomes were spontaneous pregnancy rates. A total of eleven articles were finally enrolled in, with a total of 1,743 patients. Spontaneous pregnancy rate was higher in patient with bilateral varicocelectomy than unilateral varicocelectomy with an odds ratio (OR) of 1.89 (95% CI 1.52-2.35; I = 0%; p < .00001). The results indicated bilateral is superior than unilateral varicocelectomy concerning sperm concentration (SMD: 2.88 × 10 /ml; 95% CI: 1.06, 4.70; I = 93%), sperm motility (SMD: 5.08; 95% CI: 2.65, 7.50; I = 0%), progression of sperm motility (SMD: 6.48; 95% CI: 5.16, 7.81; I = 0%) and sperm morphology (SMD: 2.38%; 95% CI: 0.72, 4.03; I = 94%) between bilateral and unilateral varicocelectomy. Bilateral varicocelectomy may be superior to unilateral in regard to spontaneous pregnancy rate and sperm motility for infertile male with bilateral varicocele (both left clinical and right subclinical varicocele and bilateral clinical varicocele).
Topics: Female; Humans; Male; Pregnancy; Pregnancy Rate; Sperm Count; Sperm Motility; Urologic Surgical Procedures, Male; Varicocele
PubMed: 31646672
DOI: 10.1111/and.13462 -
Frontiers in Endocrinology 2023Modern societies face infertility as a global challenge. There are certain environmental conditions and disorders that damage testicular tissue and may cause male... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Modern societies face infertility as a global challenge. There are certain environmental conditions and disorders that damage testicular tissue and may cause male infertility. Melatonin, as a potential antioxidant, may protect testicular tissue. Therefore, we conducted this systematic review and meta-analysis to evaluate the effects of melatonin in animal models against physical, heat, and ischemic damage to the testicular tissue.
METHODS
PubMed, Scopus, and Web of Science were systematically searched to identify animal trials evaluating the protective effect of melatonin therapy on rodent testicular tissue when it is exposed to physical, thermal, ischemic, or hypobaric oxygen stress. Random-effect modeling was used to estimate the standardized mean difference and 95% confidence intervals based on the pooled data. Additionally, the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) tool was used to assess the risk of bias. The study protocol was prospectively registered in PROSPERO (CRD42022354599).
RESULTS
A total of 41 studies were eligible for review out of 10039 records. Studies employed direct heat, cryptorchidism, varicocele, torsion-detorsion, testicular vascular occlusion, hypobaric hypoxia, ischemia-reperfusion, stress by excessive or restraint activity, spinal cord injury, and trauma to induce stress in the subjects. The histopathological characteristics of testicular tissue were generally improved in rodents by melatonin therapy. Based on the pooled data, sperm count, morphology, forward motility, viability, Johnsen's biopsy score, testicular tissue glutathione peroxidase, and superoxide dismutase levels were higher in the melatonin treatment rodent arms. In contrast, the malondialdehyde level in testicular tissue was lower in the treatment rodent arms. The included studies suffered from a high risk of bias in most of the SYRCLE domains.
CONCLUSION
This study concludes that melatonin therapy was associated with improved testicular histopathological characteristics, reproductive hormonal panel, and tissue markers of oxidative stress in male rodents with physical, ischemic, and thermal testicular injuries. In this regard, melatonin deserves scientific investigations as a potential protective drug against rodent male infertility.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022354599.
Topics: Humans; Animals; Male; Melatonin; Semen; Testis; Disease Models, Animal; Infertility, Male
PubMed: 36798664
DOI: 10.3389/fendo.2023.1123999 -
Systems Biology in Reproductive Medicine Dec 2019It is crucial to identify the subfertile men with varicocele who will benefit the most from varicocelectomy, and the factors which help in predicting the response to... (Meta-Analysis)
Meta-Analysis
It is crucial to identify the subfertile men with varicocele who will benefit the most from varicocelectomy, and the factors which help in predicting the response to varicocelectomy. We aimed to evaluate the impact of varicocelectomy on total motile sperm count (TMSC) and spontaneous pregnancy (SP) rates. A comprehensive literature search was performed using Medline/PubMed and Google Scholar up to December 26, 2018, with no restriction on language and year of publication. Published articles reporting different degrees of TMSC before and after varicocelectomy in infertile men with varicocele (palpable and/or clinical) were extracted. In addition, SP rates as a function of TMSC after varicocelectomy were reviewed. Potential biases were analyzed to rule out skewing factors. Mean TMSC was graded as: <2 million - profound, 2-5 million - severe, 5-10 million - moderate, and >10 million - mild. Data were analyzed using Stata11. Among the total 96 articles identified through electronic and manual searches of references, nine articles fulfilling the inclusion criteria were included. All degrees of TMSC resulted in a significant postoperative improvement, with only small differences, among the profound [10.20 million (95% confidence interval [CI]: 9.11-11.30, p < 0.0001)], severe [15.77 million (95% CI: 10.65-20.89, p < 0.0001)], and moderate groups [19.18 million (95% CI: 10.40-27.96, p < 0.0001)]. However, the mild group demonstrated a highly significant improvement [49.68 million (95% CI: 38.74-60.62, p < 0.0001)]. After varicocelectomy, the SP rate was highest in the TMSC >20 million group (55.4%), followed by TMSC 5-20 million group (45.4%), and TMSC <5 million group (26.3%). In comparison, the TMSC <1.5 million group demonstrated the lowest SP rate (16.0%). Moderate evidence suggests that varicocelectomy results in a significantly improved TMSC. The improvement in TMSC and SP rates is higher in patients who present a mild or moderate decreased TMSC. TMSC: total motile sperm count; SP: spontaneous pregnancy; ART: assisted reproductive technology; IVF: in-vitro fertilization; IUI: intrauterine insemination; WMD: weighted mean difference; CI: confidence interval.
Topics: Female; Humans; Male; Pregnancy; Pregnancy Rate; Sperm Count; Sperm Motility; Urologic Surgical Procedures, Male; Varicocele
PubMed: 31434522
DOI: 10.1080/19396368.2019.1655813 -
Arab Journal of Urology Mar 2018To assess the role of differentially expressed proteins as a resource for potential biomarker identification of infertility, as male infertility is of rising concern in...
OBJECTIVE
To assess the role of differentially expressed proteins as a resource for potential biomarker identification of infertility, as male infertility is of rising concern in reproductive medicine and evidence pertaining to its aetiology at a molecular level particularly proteomic as spermatozoa lack transcription and translation. Proteomics is considered as a major field in molecular biology to validate the target proteins in a pathophysiological state. Differential expression analysis of sperm proteins in infertile men and bioinformatics analysis offer information about their involvement in biological pathways.
MATERIALS AND METHODS
Literature search was performed on PubMed, Medline, and Science Direct databases using the keywords 'sperm proteomics' and 'male infertility'. We also reviewed the relevant cross references of retrieved articles and included them in the review process. Articles written in any language other than English were excluded.
RESULTS
Of 575 articles identified, preliminary screening for relevant studies eliminated 293 articles. At the next level of selection, from 282 studies only 80 articles related to male infertility condition met the selection criteria and were included in this review.
CONCLUSION
In this molecular era, sperm proteomics has created a platform for enhanced understanding of male reproductive physiology as a potential tool for identification of novel protein biomarkers related to sperm function in infertile men. Therefore, it is believed that proteomic biomarkers can overcome the gaps in information from conventional semen analysis that are of limited clinical utility.
PubMed: 29713541
DOI: 10.1016/j.aju.2017.11.016 -
Andrologia Oct 2018Varicocele is one of the common correctable causes of male infertility. Recent studies have demonstrated varicocelectomy in males with abnormal semen parameters was... (Meta-Analysis)
Meta-Analysis
Varicocele is one of the common correctable causes of male infertility. Recent studies have demonstrated varicocelectomy in males with abnormal semen parameters was associated with better fertility outcome, but the effect of adjuvant drug therapy after varicocelectomy on fertility outcome in patients with varicocele-associated infertility remains undefined. Hence, the present meta-analysis was performed to assess the efficacy of adjuvant drug therapy after varicocelectomy. The protocol was registered with PROSPERO (No. CRD42018093749). Ten randomised controlled trails containing 533 patients with adjuvant drug therapy after varicocelectomy and 368 patients with no medical treatment after varicocelectomy were included. Our analysis revealed that the improvement in pregnancy rate after adjuvant drug therapy was insignificant. (OR = 1.70, 95%CI = 0.99-2.91), but resulted in significant improvements in sperm concentration (MD = 13.71, 95%CI = 5.80-21.63) and motility (MD = 4.77, 95%CI = 3.98-5.56) at 3 months, sperm DNA integrity (SMD = 3.13, 95%CI = 1.50-4.75) and serum FSH level (MD = -1.02, 95%CI = -1.79 to -0.24). Therefore, compared to no medical treatment, the adjuvant drug therapy, especially the use of antioxidants seems to be associated with better fertility outcome. However, more evidences with high-quality studies are necessary to conform its benefits.
Topics: Chemotherapy, Adjuvant; Humans; Infertility, Male; Male; Randomized Controlled Trials as Topic; Sperm Count; Sperm Motility; Treatment Outcome; Urological Agents; Varicocele; Vascular Surgical Procedures
PubMed: 29993131
DOI: 10.1111/and.13070 -
Acta Obstetricia Et Gynecologica... Jul 2018In the work-up of patients with suspected pelvic congestion syndrome, venography is currently the gold standard. Yet if non-invasive diagnostic tools are found to be...
INTRODUCTION
In the work-up of patients with suspected pelvic congestion syndrome, venography is currently the gold standard. Yet if non-invasive diagnostic tools are found to be accurate, invasive venography might no longer be indicated as necessary.
MATERIAL AND METHODS
A literature search in Pubmed and EMBASE was performed from inception until 6 May 2017. Studies comparing non-invasive diagnostic tools to a reference standard in the work-up of patients with (suspected) pelvic congestion syndrome were included. Relevant data were extracted and methodological quality of individual included studies was assessed by the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool.
RESULTS
Nine studies matched our inclusion criteria. Six studies compared ultrasonography to venography and three studies described a magnetic resonance imaging technique. In using transvaginal ultrasonography, the occurrence of a vein greater than five mm crossing the uterine body had a specificity of 91% (95% CI; 77-98%) and occurrence of pelvic varicoceles a sensitivity and specificity of 100% (95% CI; 89-100%) and 83-100% (95% CI; 66-93%), respectively. In transabdominal ultrasonography, reversed caudal flow in the ovarian vein accounted for a sensitivity of 100% (95% CI; 84-100%). Detection of pelvic congestion syndrome with magnetic resonance imaging techniques resulted in a sensitivity varying from 88 to 100%.
CONCLUSIONS
The sensitivity of ultrasonography and magnetic resonance imaging seem to be adequate, which indicates a role for both tests in an early stage of the diagnostic workup. However, due to methodological flaws and diversity in outcome parameters, more high standard research is necessary to establish a clear advice for clinical practice.
Topics: Adult; Female; Humans; Magnetic Resonance Imaging; Ovary; Pelvic Pain; Pelvis; Phlebography; Syndrome; Tomography, X-Ray Computed; Ultrasonography; Varicose Veins
PubMed: 29381188
DOI: 10.1111/aogs.13311 -
Andrologia Nov 2019Antioxidants were proved to be efficient to improve the quality of spermatozoa after varicocelectomy. We carried out a systematic review and performed a meta-analysis to... (Meta-Analysis)
Meta-Analysis
Antioxidants were proved to be efficient to improve the quality of spermatozoa after varicocelectomy. We carried out a systematic review and performed a meta-analysis to evaluate the efficacy of antioxidant therapy in sperm parameters' quality after varicocelectomy during 3 or 6 months' treatment cycle. During research, randomised controlled trials were searched by MEDLINE, EMBASE and the Cochrane Controlled Trials Register, and necessary parameters were compared between two groups after varicocelectomy. Finally, six studies including 576 patients were included in our meta-analysis. As for sperm parameters, significant improvements of sperm concentration (p < .0001), sperm motility (p = .03), progressive sperm motility (p < .00001) and sperm morphology (p < .00001) were existed in antioxidant group 3 months after varicocelectomy. With regard to the 6 months' outcomes, sperm parameters were improved as well except sperm motility (p = .72) and progressive sperm motility (p = .57). Referring to pregnancy rate, no significant difference was existed between two groups (p = .36), and the FSH level of antioxidant group was lower than placebo group 3 or 6 months after varicocelectomy (3 months, p = .02; 6 months, p = .03). In conclusion, compared with the placebo, the antioxidant therapy after varicocelectomy can improve the quality of sperm parameters and construct a favourable living condition for spermatozoa by reducing FSH level.
Topics: Antioxidants; Female; Humans; Infertility, Male; Male; Pregnancy; Pregnancy Rate; Sperm Count; Sperm Motility; Spermatozoa; Testis; Treatment Outcome; Varicocele; Vascular Surgical Procedures
PubMed: 31423629
DOI: 10.1111/and.13396 -
International Urology and Nephrology May 2024Varicocelectomy was considered to be beneficial to patients with varicocele-related infertility. However, there are only a few researchers who have explored the...
BACKGROUND
Varicocelectomy was considered to be beneficial to patients with varicocele-related infertility. However, there are only a few researchers who have explored the relationship between better timing and postoperative semen improvement in patients.
METHODS
We conducted this meta-analysis by enrolling published prospective studies to find out the best waiting time after varicocelectomy to wait for better improvement of semen quality. An extensive search was conducted in PubMed, Web of Science, and Cochrane Library to identify eligible studies. The included studies were then analyzed comprehensively using STATA software and standardized mean differences (SMDs) and their corresponding 95% confidence intervals were calculated.
RESULTS
Our comprehensive analysis showed that after varicocelectomy, follow-up results within 3 months or longer showed a significant improvement in semen parameters compared to the preoperative period. Notably, no further improvement in semen parameters was observed when the follow-up period reached six months or longer (semen volume: WMD: - 0.07 (- 0.29, 0.16); sperm concentration: WMD: - 1.33 (- 2.33, - 4.99); sperm motility: WMD: 2.31 (- 0.55, 5.18); sperm morphology: WMD: 1.29 (- 0.66, 3.24); sperm total motile count: WMD: 3.95 (- 6.28, 14.19)).
CONCLUSIONS
Three months after varicocelectomy may be the optimal time for semen parameters compared to six months or even longer, which means it is also the preferable time for conception. However, more well-designed prospective studies are needed in the future to validate our conclusion.
PubMed: 38761331
DOI: 10.1007/s11255-024-04080-y -
Andrologia Dec 2019We aimed to define which method would be the best for the treatment of recurrent varicoceles. We analysed 21 studies to compare post-treatment improvement in semen...
We aimed to define which method would be the best for the treatment of recurrent varicoceles. We analysed 21 studies to compare post-treatment improvement in semen parameters, spontaneous pregnancy and complication rates between the treatment methods. Overall spontaneous pregnancy rate was significantly higher in the surgical methods (44.3%) than in the radiological interventions (17.9%; p = .007). Post-treatment improvement rates in sperm parameters were significantly higher in the open surgical methods (77.5%) than in the radiological interventions (62.5%; p = .032). Post-treatment recurrence rates were 3.8% in the open surgical methods, 17.6% in the laparoscopic surgery and 3.3% in the radiological interventions. However, technical failure rate was 11.8% in the radiologic interventions. To analyse open surgical methods, recurrence rate was 0.6% in the microsurgical methods and 19% in the macroscopic methods, revealing significant difference (p < .001). Post-treatment testicular atrophy rate was significantly higher in the laparoscopic surgery (2.9%) than in the open surgery (0.3%; p = .033). In conclusion, surgical methods have higher pregnancy rates and higher improvement rate in sperm parameters than radiological interventions for the treatment of recurrent varicocele. Microsurgical redo varicocelectomy has lower recurrence and testicular atrophy rates than macroscopic varicocelectomy series. Therefore, patients with recurrent varicoceles should be informed based on these findings.
Topics: Female; Humans; Male; Postoperative Complications; Pregnancy; Pregnancy Rate; Recurrence; Spermatozoa; Varicocele
PubMed: 31576594
DOI: 10.1111/and.13419